Cancer Deaths Down, Heart Disease Deaths Up Among Middle-Aged in US

Troy Brown, RN

May 23, 2019

Cancer mortality rates for middle-aged adults dropped by 19% from 1999 to 2017 and heart disease mortality rates fell by 22% from 1999 to 2011 before increasing 4% from 2011 to 2017, according to a new report from the Centers for Disease Control and Prevention (CDC).

"Cancer and heart disease are the two leading causes of death for middle-aged adults aged 45 - 64, comprising 50% of all deaths in this age range," Sally C. Curtin, MA, Division of Vital Statistics, CDC, writes in an article published online May 22 in National Vital Statistics Reports.

"Disparate trends in cancer and heart disease death rates occurred despite the fact that these two causes of death share many common risk factors. A recent study indicated that these two diseases are becoming increasingly interrelated as cancer treatments can contribute to subsequent heart disease for the growing number of cancer survivors," Curtin writes.

Curtin used information recorded on death certificates filed in all 50 states and the District of Columbia to calculate death rates for cancer and heart disease among middle-aged adults aged 45 to 64 years in the United States during 1999 to 2017. Mortality rates were analyzed by sex and race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic).

Overall Death Rates

Cancer mortality rates for middle-aged adults fell by 19% from 1999 to 2017 (224.9 deaths per 100,000 to 182.6). Annual percentage declines were larger during 1999 to 2007 and 2014 to 2017 (each 1.5% annually) than during 2007 to 2014 (0.5% annually).

Heart disease mortality death rates fell from 1999 (164.3 per 100,000) to 2011 (127.9) and then rose from 2011 to 2017 (133.6). "This recent increase in heart disease death rates for middle-aged adults was not observed for either younger or older adults — heart disease death rates for adults aged 20 - 44 declined and then levelled off, whereas rates for adults aged 65 and over declined through the entire 1999 - 2017 period," Curtin explains.

"The same trend patterns were observed for both men and women," Curtin writes. At all times from 1999 to 2017, the cancer mortality rate was higher than the heart disease mortality rate; it was 37% higher during 2017.

Death Rates by Sex

Among middle-aged men, the cancer mortality rate fell throughout the period but at varying rates, declining 20% from 1999 (247.0 per 100,000) to 2017 (197.4).

The heart disease mortality rate for middle-aged men fell 22% from 1999 (235.7) to 2011 (183.5) but then rose 3% from 2011 to 2017 (189.8).

Among middle-aged women, the cancer death rate fell 17% from 1999 (204.1) to 2017 (168.5). Declines in the average annual percentage were greater during 1999 to 2008 (1.5% annually) than during 2008 to 2017 (0.5% annually).

The heart disease mortality rate for middle-aged women dropped 23% from 1999 (96.8) to 2011 (74.9) but then rose 7% in 2017 (80.1).

Cancer death rates were higher than heart disease death rates among both middle-aged men and women; however, the difference between rates was greater among women, whose cancer-related death rates were more than double those of heart disease every year throughout the study period.

In 1999, the cancer mortality rate among men was 5% higher than the heart disease mortality rate; by 2011, it was 17% higher. "The rates for men have converged since 2011, and the cancer death rate in 2017 (197.4) was 4% higher than the comparable heart disease death rate (189.8)," Curtin writes.

Death Rates by Race and Ethnicity

Trends differed between Hispanic men and women and non-Hispanic white and black men and women.

Cancer mortality rates fell during 1999 to 2017 among non-Hispanic white and non-Hispanic black men and women. Heart disease death rates declined and then increased since 2009 for non-Hispanic white men and women, and since 2011 for non-Hispanic black men and women.

Cancer and heart disease death rates for Hispanic men and women "had periods of decline and stability," Curtin explains. The greatest percentage rise in heart disease mortality rates among all groups was seen among non-Hispanic women (12%), whereas heart disease death rates fell among Hispanic women throughout 1999 - 2017 by 37% and initially fell and recently leveled off among Hispanic men.

The cancer mortality rate fell 34% among middle-aged non-Hispanic black men from 387.2 per 100,000 in 1999 to 254.5 in 2017. Declines were greater from 2015 to 2017 (4.2% annually) than during 1999 to 2006 (2.7% annually), and lowest during 2006 to 2015 (1.3% annually).

The heart disease mortality rate for non-Hispanic black men fell 28%, going from 408.0 in 1999 to 293.9 in 2011, and then increased 7% to 314.9 during 2017.

Among non-Hispanic white men aged 45 to 64 years, the cancer mortality rate fell more during 2015 to 2017 (2.3% annually) than during 1999 to 2006 (1.3% annually) and least during 2006 to 2015 (0.1% annually). Overall, cancer death rates for middle-aged non-Hispanic white men fell 14% from 1999 (244.2) to 2017 (210.6).

The heart disease mortality rate for non-Hispanic white men fell 19% from 1999 (226.6) to 2009 (184.2) and then rose 4% between 2009 and 2017 (192.3).

Among middle-aged Hispanic men, cancer mortality rates fell by 23% from 1999 (147.8) to 2017 (114.6). The heart disease mortality rate among Hispanic men fell by 32% from 1999 (154.2) to 2011 (104.9) before leveling off from 2011 to 2017 (107.2). The cancer mortality rate (114.6) was 7% higher than the heart diseases mortality rate (107.2) in 2017.

Curtin used the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) underlying cause-of-death codes C00 to C97 to classify cancer deaths and ICD-10 underlying cause-of-death codes I00 to I09, I11, I13, and I20 to I51 to classify heart disease deaths.

"The findings in this report can inform research and prevention efforts for these two leading causes of death," Curtin concludes.

Curtin has disclosed no relevant financial relationships.

National Vital Statistics Reports. Published online May 22, 2019. Full text

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